Promotion of cycling and healthBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5405 (Published 18 October 2010) Cite this as: BMJ 2010;341:c5405
- Nanette Mutrie, professor of exercise and sport psychology1,
- Fiona Crawford, public health programme manager2
England’s chief medical officer in 2009 called physical activity a potential “wonder drug,”1 and promoting physical activity has been called a “best buy” in public health.2 In our sedentary and technologically advanced societies, population levels of physical activity are low, and knowledge about how to invest in this best buy is urgently needed. Our challenge is to find methods of making this wonder drug more palatable to more people more often⇓.
Reviews of physical activity promotion suggest that an increase in everyday walking and cycling could generate a considerable public health gain.3 The evidence base for how best to promote walking is growing.4 Cycling is also a relatively simple and effective way for people to gain an adequate “dose” of regular health enhancing physical activity, and many people have access to a bike, but we know little about how to promote this activity.
In the linked systematic review (doi:10.1136/bmj.c5293), Yang and colleagues assess the effectiveness of interventions to promote cycling, and whether promoting cycling influences overall levels of physical activity.5 The review provides a realistic assessment of what can be achieved. The results suggest that both individual and community-wide approaches to promoting cycling are needed to benefit population health but that gains would be modest (increases in the proportion of trips made by bicycle of up to around 3% in population level interventions are cited in the review). However, modest gains spread across the population would have an effect on health. Also, it is not clear whether people who take up cycling reduce other modes of activity, such as structured forms of exercise, but the review suggests this is not the case.
This review highlights several challenges and opportunities regarding the promotion of cycling. Public attitudes and perceptions influence decisions about mode of travel. A systematic review of children’s attitudes to walking and cycling concluded that policies to promote walking and cycling would be more successful if they tackled concerns about safety and promoted the capacity of children and young people to make their own choices about transport.6 Evidence suggests that reducing speed improves the safety of pedestrians and cyclists. One study found that introducing mandatory 20 mph (32 km an hour) zones in London was associated with a significant reduction in serious casualties among child pedestrians and cyclists.7 Guidance from the National Institute for Health and Clinical Excellence (NICE) on how to improve the physical environment to encourage physical activity include recommendations on transport, such as the reallocation of road space and the setting up of safe routes to school.8
The NICE guidance also stresses the importance of robust evaluation of environmental change on public health, a point that is emphasised by Yang and colleagues. Of the 25 studies included in their quantitative synthesis, only six met at least three of the five validity criteria and none of these was based in the United Kingdom, despite the fact that UK studies represented over half of those scrutinised.
Cycle loan schemes to promote cycling have now been established in Paris, Dublin, and London. Evaluators of these schemes can learn from this review. Better measures of cycling are needed, together with ways to estimate whether campaigns attract new cyclists or just improve the cycling environment for current cyclists and whether or not cycling contributes to overall physical activity. The cost of such schemes also needs to be evaluated.
The World Health Organization’s health economic appraisal tool (www.apho.org.uk/resource/view.aspx?RID=78773) for cycling ascribes a value to the health benefits arising from regular cycling. The tool shows that investment in cycling is highly cost effective, especially in comparison with investment in road building.
Increased levels of cycling as a mode of travel might also improve environmental health by reducing traffic congestion, air pollution, and carbon emissions. The estimated health benefits of cycling have been assessed as being substantially larger than the risks relative to car use, and societal benefits as a result of reduced air pollution and eventually fewer road traffic injuries have been proposed.9
A manifesto produced earlier this year by the Faculty of Public Health and the Royal Society for Public Health has called for a 25% increase in cycle lanes and cycle racks and a 20 mph speed limit in built up areas.10 Yang and colleagues’ review provides further evidence to support this prioritisation and their conclusions provide a strong argument that better measurement of the impacts of interventions on levels of cycling and physical activity is necessary not only to inform future strategy and policy but also to strengthen the case that promoting cycling represents extremely good value for money for both individual and public health.
Cite this as: BMJ 2010;341:c5405
Competing interests; All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; not externally peer reviewed.